Areas of expertise
Adult ADHD (Attention-Deficit Hyperactivity Disorder)
One of my main areas of interest and expertise is Adult ADHD. While ADHD is a relatively common neurodevelopmental condition, it can be debilitating for many people. Even though we have effective and safe treatments, ADHD remains widely misunderstood and often goes undiagnosed in adults.
- Inattention: This includes distractibility, poor concentration, and forgetfulness.
- Hyperactivity/Impulsivity: Symptoms like restlessness, agitation, and impatience fall under this category.
- Emotional Dysregulation: The majority of people with ADHD also experience extreme mood swings, brief periods of excitability, anger, or irritability.
- Sleep Issues: Problems like late sleeping, restless legs, and daytime fatigue are common.
While inattention and hyperactivity are well-known ADHD symptoms, emotional and sleep-related issues are less recognised. However, they can often be more distressing. These symptoms can lead to misdiagnoses like depression, bipolar disorder, chronic fatigue, or PTSD. Additionally, many with ADHD have other mental health challenges; 70% have at least one additional condition, and 30% have two.
Self-medication with substances
Due to a lack of ADHD services, many people turn to substances like alcohol, cocaine, cannabis, and caffeine for relief. Unfortunately, this can lead to them being labelled as substance use disorders and denied professional help. However, treating ADHD has been shown to reduce substance use significantly. Students have been known to misuse ADHD medication in a misguided attempt to improve their academic performance. However, recent studies suggest that most students who take stimulants are likely to have undiagnosed ADHD.
I take an empathetic and pragmatic approach to substance use. I believe most people turn to substances to cope with life's challenges. To truly help, we need to address the underlying emotional and physical issues; otherwise, breaking the cycle can be tough.
Families with ADHD
ADHD is proven to run in families. It’s a genetic condition, which means that if you have ADHD, there's a good chance that your parents, brothers, sisters, or your kids might have it too. Becoming a parent can make ADHD symptoms worse, particularly when combined with a lack of sleep. It's common for patients to find out they have ADHD when they become parents and their child is diagnosed. That's why I believe it's so important to understand these unique factors and adjust treatment to fit you. I also think it's helpful to involve families in the treatment process, as this can make a big difference in reducing stress and creating a happier home.
Treatment for ADHD
Empathy is at the core of my approach. I encourage patients to shift their self-perception, moving from thinking they "wouldn't" do something (like study or organise) to understanding they "couldn't" due to their ADHD. Medications for ADHD, primarily stimulants, are highly effective and safe compared to many mental health medications. However, there are myths about these drugs being addictive or misused. A significant part of my role is to educate and reassure patients about these concerns.
I'm deeply passionate about treating bipolar disorder, especially understanding the overlap between bipolar and ADHD. Despite over 70 years of research, it's concerning how often Bipolar remains undiagnosed. Sadly, many people face a delay of up to ten years before receiving a proper diagnosis.
There are many reasons why bipolar might be misdiagnosed as something else. For instance, people might have been mistakenly diagnosed with a "personality disorder" or have their symptoms ignored. Additionally, if someone has experienced trauma, their emotional issues are sometimes blamed only on that trauma, missing other possible conditions like bipolar or ADHD. This can lead to years of therapy without much benefit.
My approach to treating bipolar involves the following steps:
- I prioritise understanding each patient's unique experience. I provide information about various symptoms and mood swings associated with different disorders, allowing patients to reflect and return for a reassessment.
- I consistently check for other conditions that might coexist, such as ADHD, sleep disorders, and anxiety disorders. Some patients might have milder forms of bipolar disorder, termed "bipolar spectrum disorder." Distinguishing this from mood swings in other conditions can be intricate, but open communication with patients is crucial.
- I explain terms like "highs" or "manic behaviour," which can mean different things in daily life versus a clinical context.
- If a clear diagnosis isn't immediately possible, I focus on treating the most distressing symptoms first. Over time, the diagnosis often becomes clearer. Educating my patients empowers them to recognise symptom relapses by managing them or seeking appropriate help.
To help patients manage and understand their symptoms, I have created a monitoring tool to track their symptoms. With it, patients can easily record their daily mood, sleep, anxiety, energy, and ADHD symptoms. By looking at these factors together, we can spot trends and learn how to tailor treatment for each person.
Everyone feels worried or anxious at times, especially during major life changes or challenges. These feelings can actually be helpful, pushing us to find solutions during tough times. Historically, these emotions developed in humans and animals as a way to protect ourselves and our families. It's also worth noting that while many people experience intrusive thoughts at some point in their lives, only a small percentage have conditions like Obsessive Compulsive Disorder (OCD).
When feelings of anxiety start causing physical symptoms or major disruptions in daily life, they might be classified as 'anxiety disorders'. Sometimes, symptoms like restlessness or overthinking, which might be due to other reasons like insomnia or ADHD, are mistakenly thought to be signs of anxiety. It's essential to differentiate these symptoms to provide the right treatment, which is why I will assess you carefully before making a diagnosis. We'll discuss if your symptoms align with specific anxiety disorders like general anxiety disorder (GAD), social anxiety disorder, phobia, or OCD. Rest assured, my goal is to support and guide you through this journey. I'm here to help and will work at a pace that's comfortable for you.
My approach to treatment
It's natural to feel a bit anxious or unsure before our meeting, and that's okay. My main goal is to make you feel comfortable. I'll ensure you understand my questions and help you answer at your own pace. You might feel unsure about what to anticipate or worry about recalling all the necessary information. Let me reassure you it's my role as your psychiatrist to ensure you feel at ease throughout this process. Together, whether it's one meeting or many, we'll understand your situation, explore potential reasons for your challenges, and create a treatment plan that fits your life and needs.
Your first consultation
Our first consultation is dedicated to establishing a strong foundation for our therapeutic relationship, making sure our future conversations are open and easy. I will always listen to your perspective, but there might be moments when I guide the conversation to keep us focused. Early in our conversation, I'll assess your level of familiarity with your symptoms and your viewpoints about your diagnosis. If you've done extensive research, I'll spend more time listening to your insights. This way, you can feel valued and heard. If you come in feeling unsure of what to expect, I'll gently take the lead in our conversation to make the process easier for you.
Before our consultation, I suggest you write down your concerns and past experiences. Writing this down will give you ample time to reflect on your symptoms, involve loved ones in your reflections, and, during our appointment, revisit or modify what you've shared. I highly value your perspective, especially since you have likely invested considerable time researching possible conditions before seeking help.
I'll regularly summarise and verify the information we discuss throughout our appointment. For those who may have or are suspected of having ADHD, I might suggest pacing the room or taking breaks, while answering questions to help you stay focused. All of these steps are part of my approach to making our consultations as beneficial and comfortable for you as possible.
Following the comprehensive assessment, we'll develop a shared understanding and agreement about any diagnoses, including the implications on your life, such as relationships, work, and treatment options.
Personalised treatment plans
I understand that life doesn’t stop just because you’ve decided to seek help, and I always accommodate treatment schedules around your life circumstances. For instance, you might have been planning a holiday but are now dealing with severe symptoms. Starting a new medication might not be the best course of action right now, yet cancelling your plans could lead to feelings of guilt. Likewise, I'll shape your treatment plan considering other important life responsibilities, like childcare, shift work, upcoming work or academic deadlines, or navigating through a bereavement.
To develop a personalised treatment plan, I’ll begin by carefully asking about your current lifestyle, social and personal priorities, and personal goals.
Understanding Your Condition
I believe that understanding your condition is crucial. That's why I focus on 'psychoeducation', which means explaining your illness in terms you can relate to. In today's world, where specialist help can be limited, knowledge is your best tool. It empowers you to actively participate in your treatment. I've also designed a tool for you to track your progress. Think of it as a visual journey map you can place on your wall. I want you to truly understand and take charge of your health, and I'm here to guide you every step of the way.
In this digital age, many turn to the internet for information. While there's a wealth of knowledge online, not all of it is accurate. Instead of advising you to avoid online research, I encourage you to explore but with caution. I'll help you differentiate between reliable and misinformation.
I'm a big believer in the power of therapy, whether it's through counselling or more structured methods like Cognitive Behavioural Therapy (CBT). But here's the thing: diving into therapy without being ready can lead to feelings of failure.
So, before we start, I like to get a feel for where you're at. Do you have other things going on, like ADHD or sleep troubles, that we should consider? I use the CBT five-areas approach, which looks at thoughts, emotions, behaviours, situations, and physical symptoms. This helps us see the bigger picture and understand how different areas interplay. We might also try exposure exercises, confronting your fears in a controlled, safe way. If I think a specific therapy would be beneficial, I'll refer you to a psychotherapist and collaborate with them for your care.
When it comes to medication, my goal is to try to improve your quality of life, not just your symptoms. Medication can be highly beneficial for treating certain mental health conditions, such as bipolar, severe depression, anxiety, or ADHD. These conditions are more likely to need medication due to underlying brain changes, possible hormonal influences, and genetic causes. Over the years, I've seen many struggle with lifestyle changes or therapy when not on medication. Once on the right medication, their efforts often yield better results. In my view, the right medication can provide the necessary support for these changes.
If you decide to take medication, we'll try one at a time. This way, we can carefully watch how it works for you, noticing the benefits and any possible side effects. I’m very open and honest about side effects and will provide strategies to manage them. If you have upsetting side effects, such as body image or weight gain issues, we'll face them together. These can be particularly significant for younger people, and I take them very seriously.
I want to make sure you understand everything about your medication before taking it. I'll give you leaflets as well as show you simple diagrams and pictures to explain how your medicine works. My aim is to help you feel informed and confident about the medication and its actions.
Education & Training
I’m an Adult Psychiatrist with 23 years of clinical experience in psychiatry and 13 years of experience in ADHD. I’m registered with the General Medical Council (GMC) and the Royal College of Psychiatrists.
I’m currently based in Leicestershire, working as a Consultant Psychiatrist in the NHS and developing my private practice. Beginning in July 2019, for 4 years, I was a Staff Psychiatrist in the regional tertiary-care Mood and Anxiety Programme at the Royal Ottawa Mental Health Centre in Ottawa, Canada. Prior to this, I dedicated 13 years as a General Adult Consultant Psychiatrist with the Charnwood Community Mental Health Team in Leicestershire. In 2010, I jointly developed the local specialist Adult ADHD clinic in Leicestershire.
Alongside my clinical work, I’ve had research and teaching commitments as an Assistant Professor in the Department of Psychiatry, at the University of Ottawa. During my tenure, I played a key role in enhancing patient pathways and educational programs. Here I was honoured with the prestigious 'Lauria Streno Team Champion Award'. This award was for a teaching program I organised on Bipolar Affective Disorder, which significantly elevated patient care standards. Additionally, I secured funding for a study evaluating an online educational program for the same disorder.
Regarding my education, I received a Modular Certificate in Psychopharmacology from the British Association of Psychopharmacology and a Medical Science Diploma in Psychiatry from Nottingham University. I completed my psychiatric training at the Royal College of Psychiatrists, London and earned my Degree in Medicine from Amravati University, India.
Over the years, I have been an invited speaker at numerous lectures on various aspects of Adult ADHD, locally, nationally, and at an international conference. I successfully organised the first East Midlands Adult ADHD conference in 2018. I also introduced a lecture on Adult ADHD in our hospital's formal psychiatric training (MRCPsych) teaching programme. I was the local (East Midlands) representative for the UK Adult ADHD Network (UKAAN), the largest organisation providing training and research on Adult ADHD in the UK.
Some of my key publications include:
- Clinical Diagnosis of Depression in Primary Care: A Meta-analysis. The Lancet (2009).
- Setting up Adult ADHD Service in the United Kingdom in Cutting Edge Psychiatry in Practice (2012).
- International comparison of clinicians' ability to identify depression in Primary Care: meta-analysis and meta-regression of predictors in the British Journal of General Practice (2011).
I’m interested in cricket, badminton, reading, and travelling. Whenever possible, I’ve tried to give something back to society through direct charitable contributions, organising or participating in fundraising sports tournaments, or providing education and personal time in community activities.